Interplay between patient global assessment, pain, and fatigue and influence of other clinical disease activity measures in patients with active rheumatoid arthritis
Interplay between patient global assessment, pain, and fatigue and influence of other clinical disease activity measures in patients with active rheumatoid arthritis
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DOI：
10.1007/s10067-015-2968-0
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发表时间：
2015-07-01
影响因子：
3.4
通讯作者：
Madsen, Ole Rintek
中科院分区：
文献类型：
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作者：
Egsmose, Emilie Lund;Madsen, Ole Rintek
风湿病患者报告的结果测量之间的相互作用尚未得到很好的澄清。该研究的目的是检查活动性类风湿关节炎（RA）患者在日常临床中通过视觉模拟量表（VAS）评分的患者总体评估（PaGl）、疼痛和疲劳在组水平上的相关性和个体水平上的一致性。还研究了与其他疾病活动指标的关联。221例计划开始生物治疗的RA活动性患者的传统疾病活动性数据从丹麦DANBIO登记处提取。采用多元回归分析检验VAS PaGl、疼痛和疲劳（0-100）之间的关系。根据Bland-Altman方法，VAS评分之间的一致性表示为偏差（个体内评分的平均差异）和95%的一致性下限和上限（LLoA; ULoA）。平均年龄57±14岁，平均疾病活动评分（DAS28-CRP4） 5.0±0.9，平均PaGl 63.6±22.6。疼痛和疲劳最能预测PaGl， PaGl和疲劳最能预测疼痛，PaGl和疼痛最能预测疲劳（β值范围为0.17 ~ 0.69,p < 0.01 ~ 0.0001）。更客观的衡量标准没有或远没有那么具有预测性。LLoA;PaGl与疼痛的ULoA[偏差]为-19.1；29.5 [5.2], PaGl vs. fatigue -22.8；28.6[2.9]，疲劳vs疼痛-29.2；33.8[2.3]。总之，PaGl、疼痛和疲劳是相互解释的最有力的，而不是更客观的疾病活动的临床测量，在组水平上几乎相同。然而，在个体患者水平上，得分之间的差异差异很大。当涉及到日常临床中的单个RA患者时，研究结果强调了理解和处理传统的患者报告的VAS测量的挑战。
The interplay between patient-reported outcome measures in rheumatology is not well clarified. The objective of the study was to examine associations on the group level and concordance on the individual patient level between patient global assessment (PaGl), pain, and fatigue as scored on visual analog scales (VAS) in the daily clinic by patients with active rheumatoid arthritis (RA). Associations with other measures of disease activity were also examined. Traditional disease activity data on 221 RA patients with active disease planned to initiate biological treatment were extracted from the Danish DANBIO registry. Associations between VAS PaGl, pain, and fatigue (0-100) were examined using multiple regression analysis. Concordance between the VAS scores was expressed as the bias (mean difference between intra-individual scores) and the 95 % lower and upper limits of agreement (LLoA; ULoA) according to the Bland-Altman method. Mean age was 57 +/- 14 years, mean Disease Activity Score (DAS28-CRP4) 5.0 +/- 0.9, and mean PaGl 63.6 +/- 22.6. PaGl was most strongly predicted by pain and fatigue, pain by PaGl and fatigue, and fatigue by PaGl and pain (beta ranging from 0.17 to 0.69, p < 0.01-0.0001). More objective measures were not or far less predictive. LLoA;ULoA [bias] for PaGl vs. pain was -19.1; 29.5 [5.2], for PaGl vs. fatigue -22.8; 28.6 [2.9], and for fatigue vs. pain -29.2; 33.8 [2.3]. In conclusion, PaGl, pain, and fatigue were most strongly explained by each other, not by more objective clinical measures of disease activity and were nearly identical on the group level. On the individual patient level, however, differences between the scores varied considerably. The findings highlight the challenge of understanding and dealing with traditional patient-reported VAS measures when it comes to individual RA patients in the daily clinic.